Living Free with Type 2 Diabetes - A Healthy Lifestyle Worksahealthylifestyleworks.com/wp-content/uploads/2010/09/... · 2011-05-04 · LIVING FREE WITH TYPE 2 DIABETES: A Complete

Living Free with Type 2 Diabetes

Living Free with Type 2 Diabetes A complete lifestyle guide

and companion to Living Free Diabetes CDs

Living Free: Simple and Easy Steps for Managing and Preventing Diabetes

Copyright 2007 Lisa Atkinson, Alice Greene, Ann Seelye. All rights reserved.

No parts of this book may be reproduced or transmitted in any form or by any means, mechanical or electronic, including photocopying and recording, or by any information storage and retrieval system, without the permission in writing from the author or publisher, except by a reviewer who may quote brief passages in a review.

ISBN 978-0-557-08098-4

LIVING FREE WITH TYPE 2 DIABETES: A Complete Lifestyle Guide

Living Free Diabetes © 2008 Page i

TABLE OF CONTENTS

Understanding How to Reduce and Control Blood Sugar Levels 3 4 Types of Diabetes Why Exercise? Glucose Guidelines for Exercise Exercise as Medication Exercise Safety Protocols

Exercise That Feels Good 13 Choosing How Often & How Long to Exercise Moderation is the Key How to Safely Progress With Exercise What Counts as Exercise How to Use the Diabetes Fitness Diary How to Use Steps to Set Goals Stretching After Exercise Strength Training Tips

Balanced Eating for Glucose Control 26 A Simple, Enjoyable Way to Eat Hunger Signals Balancing foods The Story Behind Carbohydrates Recognizing Carbohydrates, Proteins and Fats Which Carbohydrates Have the Highest Glycemic Index? Balancing Foods to Lower the Glycemic Load Eliminate Diet Thinking of Bad Foods Changing How You Treat Yourself Snacking to Maintain Stable Glucose Levels Journaling as a Discovery Tool

Lifestyle Changes for Prevention & Management of Diabetes 40 Lifestyle Choices that Improve Glucose Levels Lowering Stress Levels Addressing the Challenges of Lifestyle Changes Overcoming the Obstacles How to Help Yourself Make Healthy Changes Getting & Staying Motivated to be Healthy

My Lifestyle Diary 52 Creating a Vision of Being at Your Best Planning For the Week Weekly Self Progress Tracking Week’s Worth of Journal Pages Weekly Accomplishments, Observations & Assessment Journaling Thoughts Additional Resources


Living Free Diabetes © 2008 Page ii


Living Free Diabetes © 2008 Page 1

Introduction

Welcome! We know how hard it is to live your daily life while managing your blood sugars, and our goal is to give you some easier and simpler ways to feel more in control, be informed and have choices that suit your preferences, lifestyle and situations. This is why we have written this easy-to-use guidebook to give you information, many tools, journals and logs to guide you through the process of managing and preventing diabetes so you can “Live Free”. The basic guidelines for eating, exercise and lifestyle apply to everyone, not just diabetics, so you are not alone in creating healthier choices. The first section of the guidebook gives you information about why it is important to control your blood sugar level, how exercise works to help you with that and some basic guidelines for safety. Each of the next three sections covers one important aspect of managing and preventing diabetes: exercise, eating and lifestyle factors. The final section puts it all together in a weekly format that you can use over and over again. You will learn how to incorporate exercise and an easy eating approach to make changes in your daily routine that will make you feel better and give you even greater control over your blood sugar levels. Each chapter will introduce you to the basics, give you guidelines, and teach you techniques that you can use to track your progress and measure your success. We give you everything you need. As you first flip through the pages of this guidebook you may feel overwhelmed and wonder, “Where do I start?” There is not one right way because everyone is different. Here are some possibilities: • You could quickly read the whole guidebook and see which section makes sense for

YOU to start with and go there. • You could read Part One which has basic information and then go to Part Two and

start with exercise. Once you have established some changes with exercise you could move on to eating, etc.

• You could start with the vision sections on pages 54 to 55 and 68 to 69. Doing this kind of thinking, imagining and journaling can help set the tone and clarify for you WHY you even want to address your health. This will then guide you into beginning to take actions that you know will make a difference.

These are just some suggestions. Make this guidebook your own. Use it fully or just use the parts where you need support and guidance. We believe that you can change and create the life of health, vitality and well-being you deserve and live freely with diabetes. We wish you well in the process, Lisa, Alice & Ann



Disclaimer This workbook is not intended as treatment for diabetes. You should consult your physician before starting any program for diabetes control. The journaling exercises are intended to help you gain insight into how your body is reacting to the lifestyle changes that you begin to make. If you find your glucose levels do not improve or get worse, contact your physician for additional guidance.



Understanding How to Reduce & Control Blood Glucose Levels


There are 4 Types of Diabetes Type 1 is when the beta cells in the pancreas, where insulin is made, do not work properly and there is little or no insulin for the body to use. So basically, a Type 1 diabetic does not make any insulin themselves and they need to inject insulin daily to live.

Type 2, or adult onset diabetes, is where the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance.

Gestational Diabetes only occurs for women during pregnancy. This only occurs when the hormones related with the pregnancy cause the body’s cells to become resistant to insulin, just as in Type 2. For most women, this condition will reverse itself once the baby is delivered.

Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. If this is you, this is the stage when changing lifestyle and eating habits can help prevent you from developing a diagnosis of Type 2 diabetes.

Type 2 Diabetes Normal Insulin Response

As you can see from these two pictures, when there is enough insulin present, it will open the door of the cell and let in the glucose, but when there is more glucose than insulin, it cannot open the door and the glucose continues to circulate in the blood stream.




Why Exercise?

Exercise moves glucose into the muscles for use as fuel the same way that insulin does. Insulin works to move glucose into the body’s cells for fuel.

Exercising muscles pull glucose out of the bloodstream to move it into the muscles for fuel.

Guidelines for exercising with diabetes:

When to exercise – exercising at peak insulin effect is more likely to cause a hypoglycemic response. You should wait usually 1 – 1½ hours after eating. How long to exercise – longer exercise = greater glucose lowering effect. If you will be exercising for longer than 30 minutes you should eat a snack, or bring one with you. How intense to exercise – harder exertion = greater glucose lowering effect. Be aware of how intensely you are exercising and have a snack with you. Bring a snack – to avoid hypoglycemia:

Appropriate snacks should contain 10-15 grams of Carbs, such as: Lifesavers 7 Fresh Fruit 1 Bread 1 slice Orange juice ½ cup Sports drink (= 10% carbs) 1 cup

The Warning signs of hypoglycemia (low blood sugar) are: Trembling or shakiness Nervousness Rapid heart beat Increased sweating (which may not be noticeable if you’re exercising) Headache Impaired concentration or attentiveness And finally, Unconsciousness and coma



Glucose Guidelines for Exercising

Glucose levels should be between 90 mg/dl and 270 mg/dl to exercise:

You Do Not Want to Workout if: Below 90 mg/dl – There will not be enough glucose available for exercise causing many problems ranging from mild hypoglycemia to severe low glucose levels with the possibility of fainting, coma, seizures and brain damage. Eat or drink some carbohydrates first. Over 270 mg/dl – If your sugar is too high, your control is poor and your muscles are probably more resistant to using the circulating glucose. At the same time, your liver will continue producing more blood sugar thinking that your muscles are using what is already circulating for energy. This will cause your blood sugar levels to soar skyward.

Ketones are present in your urine because it indicates high blood sugar levels and poor control. It would be the same as having blood sugar levels of over 270 mg/dl.

The symptoms for hyperglycemia (high blood sugar) are: Frequent urination Great thirst Nausea Abdominal pain Dry skin Disorientation Labored breathing Drowsiness

Timing of your exercise sessions can be as important as timing your medication.

If you exercise in the morning, you have a much lower risk of low-blood sugar or hypoglycemia. That is because insulin levels are usually lowest in the morning, so you will not be at risk for a double glucose drop. On the other hand, if you exercise in the late afternoon or early evening it could cause hypoglycemia overnight during sleep, if insulin and diet are not adapted. Exercise acts as insulin. Therefore, it is the same as taking medication (or insulin). So, a diabetic who exercises to control blood sugar levels should try to exercise at the same time each day and for the same duration and intensity level. We realize that this is not always possible. We encourage you to exercise when you can, and as safely as you can. Try to keep records of how your body is reacting to each exercise session and the time of day. Discuss all options with your doctor.



Exercise as Medication

Tracking your glucose Keeping track of your glucose numbers before, during and after exercise can help you determine how much insulin is being used during your exercise sessions and help you determine if there is a time of day that will be better for exercise.

Begin by writing down what days of the week you want to exercise: Then, determine what time of day will work best with your schedule (don’t worry if it is not the same time each day) Finally, determine what type of exercise you will do, and for how long: Example: walk for 30 minutes Now, every time you exercise, write down your glucose level before and after, and again 2 hours after. Before Exercise After Exercise 2-hr After Exercise _____________ ____________ ________________ _____________ ____________ ________________ _____________ ____________ ________________ _____________ ____________ ________________ _____________ ____________ ________________ _____________ ____________ ________________ _____________ ____________ ________________



Exercise Safety Protocols

There are certain things you need to remember before you start an exercise program: a. Glucose monitoring: must be able to self monitor glucose levels.

b. Food planning: always bring a snack with you, at least 15 grams of a carb. If you plan to workout for less than 1 hour, you probably will not need a snack. If you plan to workout for more than one hour, have a snack every 30 minutes of exercise.

c. Wear ID bracelet: in case of hypoglycemic response. Try www.n-styleid.com.

d. Exercise with a partner – if possible, until your response is known.

e. Wear good shoes: Use sneakers with good support. Always wear polyester or cotton-polyester socks to minimize trauma and dryness.

f. Good hygiene – Always check feet before and after exercise for lesions.

g. Drinking enough water: Bring a water bottle with you and drink from it at least every 15 minutes of exercise.

22-309 – 153 – 4Ultralente

18-286 – 81 – 3Lente

18-285 - 81 – 2NPH

6 - 82 - 3½ - 1Regular

3 - 5½ - 1 ½¼ - ½Lispro

Duration Effect(time in hours)Peak Effect

Time to OnsetInsulin

Action of Types of Insulin

22-309 – 153 – 4Ultralente

18-286 – 81 – 3Lente

18-285 - 81 – 2NPH

6 - 82 - 3½ - 1Regular

3 - 5½ - 1 ½¼ - ½Lispro

Duration Effect(time in hours)Peak Effect

Time to OnsetInsulin

Action of Types of Insulin

Amount of time it may take to reach Peak Insulin Effect (highest concentration of Insulin in your bloodstream) and how long that effect may last.

Taken from: The Healing Power of Exercise: L. Goldberg, MD and D. Elliot; MD. John Wiley & Sons Publisher, 2000



Summary Insulin works to move your glucose from your bloodstream into your cells for fuel.

Exercising muscles work the same as insulin, by moving glucose from your bloodstream

into your cells for fuel. You should not exercise if your glucose levels are below 90 mg/dl or above 270 mg/dl or

if you have ketones present in your urine. If you inject insulin, you need to be aware of where you are injecting it before exercise

and when it will be at peak concentrations so you will know when it is safe to exercise.

References

The Healing Power of Exercise by L. Goldberg, MD and D. Elliot; MD (2000) New York: John Wiley & Sons Publisher Understanding Diabetes by J. W. Norwood, C. B. Inlander, and People’s Medical Society (1999) Handbook of Exercise in Diabetes American Diabetes Association (2002) Diabetes Prevention Program The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Exercise for the Health of It Joslin Diabetes Center Education Library

Photo Sources

Page 5: Exercise Physiology: Energy, Nutrition and Human Performance 5th ed, by McArdle Katch & Katch (2001)



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Weekly Observations – also in My Lifestyle Diary Weekly Observations – also in My Lifestyle Diary

Did you schedule exercise this week? Did you schedule exercise this week? _____________________________________________________________________ _____________________________________________________________________

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Did you monitor your glucose levels? What do you learn from that? Did you monitor your glucose levels? What do you learn from that? _____________________________________________________________________ _____________________________________________________________________

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What was challenging this week? What do you learn from that? What was challenging this week? What do you learn from that? _____________________________________________________________________ _____________________________________________________________________

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What are some things you can do this next week that will help you continue to exercise? What are some things you can do this next week that will help you continue to exercise? _____________________________________________________________________ _____________________________________________________________________

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Exercise That Feels Good for Health, Weight Loss &

Reducing Blood Sugar Levels



Choosing How Often & How Long to Exercise

A good guideline for exercise is: 3-5 days during each week. Minimum of 120 minutes total aerobic activity per week. Average of 150 minutes per week. Above 150 minutes per week for those who are fit.

This is similar to the exercise guideline from the American Diabetes Association 150 minutes of exercise per week.

Ways to structure weekly exercise times Ideally you will find time at about the same time of day five days a week

Lunchtime for 30 minutes x 5 days a week = 150 minutes. After work for 35 minutes x 4 days a week = 140 minutes. Weekends and during the week for 50 minutes x 3 days a week = 150 minutes.

You can break up the time

Take a 20 minute walk at lunchtime and a 10 minute walk before dinner or work. Get off the bus 1 stop ahead of yours and walk the rest of the way.

Be creative and see where you can fit in activity that you didn’t think was possible

Getting Started If you haven’t been exercising for a while, start from where you are and build up. Start with 5-10 minutes of exercise a day and gradually add more time. Once you start moving it gets easier.

Weight Loss Minimum of 150 minutes per week (after building up ability to do this). 5-6 days per week, with a day off each week for rest and avoiding overuse injuries.

Research results A loss of 5-7% body weight significantly benefits the heart and reduces the chances of

getting diabetes by 71% in pre-diabetics over the age of 60. Those that exercised 150 minutes/week, modified their eating and lost 5-7% of their body

weight lowered their risk of getting Type 2 diabetes by 58%. For a 200 pound person, a 5-7% loss is 10-14 pounds. For every 10 pounds lost, insulin sensitivity improves by 20%.



Moderation is the Key The aerobic exercise guideline for diabetics is moderate intensity. An easy way to determine what is moderate intensity is to notice how easy or hard it is to talk while moving and what it feels like to you. This is your own perception, yet it is a fairly accurate gauge of how much effort (or intensity) the exercise is for you. The gauge has a name, which is the Rate of Perceived Exertion (RPE).

The Rate of Perceived Exertion (RPE) scale is a way to measure exercise effort level – also called exertion or intensity. The way to use RPE is by noticing how easy or difficult it is to talk Start with being able to easily talk at a RPE level of 3. Progress over time to a level 6-7 when talking starts to be affected and it takes some

effort to speak a full sentence at a time or to maintain a conversation.

Rate of Perceived Exertion Scale

The Scale runs from 1-10 1 is very easy. It is strolling and a slow paced movement. 10 is extremely difficult. It is running so hard you can hardly breathe.

Benefits of moderate intensity exercise (in the range of 3-6 on the RPE Scale) Lowers risk of heart disease and stroke. Helps prevent or manage diabetes by lowering glucose levels and insulin resistance. Reduces high blood pressure. Reduces feelings of depression and anxiety. Builds and maintains healthy bones, muscles and joints. Helps older adults be strong and better able to avoid falls.

1 2 3 4 5 6 7 8 9 10

ModeratelyEasy

Difficult

50% 60%.............................................85% of max HR

ModeratelyHard

Fat Burning Zone

2-3 Easy Can talk with no problem – feels easy4-5 Moderately Easy Talking is still fairly easy – feeling bit of exertion6-7 Moderately Hard Talking takes more effort – feeling like some work8 Difficult Can’t keep up a conversation – feeling like hard work9-10 Extremely Difficult Can’t really talk at all



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How to Safely Progress With Exercise Progressing at the pace that is right for your body is very important

Listen to how you are feeling and what you feel your body can do When you are ready to do a bit more: First: Increase frequency (the number of times you exercise each week). Second: Increase duration (how long you exercise each time). Third: Increase intensity (your level of effort) by moving faster or going up small

hills, which increases the RPE from 3-4, then 4-5, and up to 5-6.

What Counts as Exercise? Any form of movement using your big muscle groups (leg and buttocks muscles) that gets your heart rate up and affects your breathing a bit, continuously for 10 minutes or more. Choose activities you enjoy or at the very least that you can tolerate, so you will be more likely to do them. Add variety into your choices to prevent boredom, burnout and overuse injuries.

Ideas: Walking, biking, dancing, gardening, cleaning, videos/DVDs, swimming, tennis, elliptical machine, playing tag with your kids, using the hula hoop, rowing. What do you like to do? ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ What would you like to be able to do? Do you have a dream or desire to take a biking vacation, walk around New York City, hike in the mountains, walk up stairs easily, learn a new sport, or enter a race? Write down what comes to mind. To be successful it helps to have clear goals and desires that are motivating to you. You can always come back and add to this list.

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How to Use a Diabetes Fitness Diary Diabetes Fitness Diary

Understanding the Diary Layout

Above is an example of a diary that has been filled out. The journal is for a full week of aerobic activity

The days of the week appear on the left side of the page. For each day there are 3 rows of information (goals, actual and comments).

For each day, there are column headings

Day and Date. Type of Exercise. Duration (in minutes). Place to record glucose levels. Place to record stretching. Steps – for exercise and for the day.

Type of ExerciseHeart Rate RPE (0-10)

Duration (Minutes)

Pre Exercise Glucose Level

Post Exercise Glucose Level

2 hr Post Exc Glucose Level

Stretches Number of

STEPS Exercise

STEPS Daily

DAY DATE

GOAL Walk Record 15 2 Record Record

ACTUAL Walk 2 15 2 1010 3777

GOAL Rest Record

ACTUAL Rest 2719

GOAL Rest Record

ACTUAL Rest 3452

GOAL Rest Record

ACTUAL Rest 2536


ACTUAL Walk 3 18 0 1322 5011

GOAL Rest Record

ACTUAL Walk 2 20 2 1385 3810


ACTUAL Rest 3047

TOTALS 3 Days 53 3717 24352

142

174 161 139

NAME Jane Doe WEEK # 1

COMMENT

133 123 119

COMMENT

COMMENT

Sun 1/22

Fri 1/20

COMMENT

190 165

COMMENT

COMMENT

Sat 1/21

1/16

Tues

Thurs 1/19

Wed 1/18

1/17

COMMENT

Mon 1/16



How to use the Diabetes Fitness Diary

Filling in the Journal Put your name and the week number (say 3 if it is your 3rd week of using the diary).

Day and Date Then put the day of the week and the date in the two columns on the left, starting with the

day of the week that is best for you. Then fill in the dates for the rest of the week. Setting Goals There is a line for each day to write down your goals. There is also a line to write down what you actually do, and it can be on a different day.

Type of Exercise Think about your week and what you feel you can do in setting goals for the week. How many days do you want to aim for this week? What would be the best days to schedule exercise? On those days, write your goal. Is it to walk, ride your bike or use the elliptical at the gym? On the days you don’t plan to exercise, write REST – because it isn’t a scheduled exercise

day. You may still be active and move around or do non-aerobic activity like yoga. Rate of Perceived Exertion (RPE) In this column write the word RECORD, to remind you to record your Rate of Perceived

Exertion. Or you can set a goal for your RPE intensity level. You could decide that on Tuesday you

want to aim for an RPE of 4 (moderately easy), so you would write 4 on the Goals line.

Duration In this column write how long you plan to exercise in number of minutes.

Glucose Readings In these 3 columns, record your glucose levels before, after and 2 hours after exercise. This is to see the effect of exercise on your blood sugar levels to help you manage them, to

see trends, to know if you need to eat, and to show your doctor. Stretch This column is to set goals for stretching after exercise. Don’t stretch before exercising. See the stretching examples on page 8.

Steps The Steps columns are for those using a pedometer, which is a very motivating tool. You can set goals for steps during exercise and for steps for the whole day. During the first week of wearing a pedometer just record your numbers to get a baseline of

current step levels. Then you can set goals to gradually increase your activity both during exercise and all day

long. You can also use these columns to record something else of interest to you like “Hours of

Sleep” or “Water Consumed”.



How to Use Steps to Set Goals

Many diabetics like to use a pedometer to get motivated Setting a goal to walk a specific number of steps is a great way to be self-motivated. You can see easily how much you’ve done and how far you have to go towards your goal. It is fun to see the numbers increase over time.

Setting Step goals The Surgeon General’s recommendation is the equivalent of 10,000 steps a day for long-term

health and reduced risk for chronic disease. That doesn’t mean you should attempt to reach 10,000 steps per day your first week. In fact,

you do not want to attempt this. You want to start off slowly and at your own pace to avoid injury.

First learn how many steps you take in an average week. Then begin with setting goals for a few days of exercise and see what the step counts are.

Week 1 The first week, do not set any goals. Simply write down the actual number of steps you have taken each day. You want to learn what your current level of activity adds up to in steps. You want to know what is a realistic goal for you based on your abilities.

Week 2 Once you have a baseline of your current activity level from week 1, decide how many days

of exercise you will do for week 2. This week, again don’t set any goals. Simply write down the actual number of steps during the time you exercised and also for the

entire day. The # of steps you take during exercise gives you information about what is realistic for you.

Week 3 on – Progress at the right pace for you Now you know how many steps you take during your exercise time.

Exercise Specific Goals This week, set your exercise goals based on this information. If you did 812 steps during

your walk and you want to increase your walk a bit – then make your goal for that day 900. Daily Step Goals Now set daily goals based on what you typically do in a day and on your goals for exercise.

Weekly Step Goals You can also set goals for the week. If the total number of steps taken last week was 24,352,

then you can set a new goal for the week at 29,000. This new goal is based on a 10-20% increase over the previous week, which is a good

way to set new goals. 24,352 x 1.1 = 26,787 (10% increase). 24,352 x 1.2 = 29,222 (20% increase).

To determine how much that is per day, simply divide 29,000 by 7 to get 4,100, OR pick a number (200 steps) and add that to your daily average and use as your daily goal.

Another rough target is 12,000 – 15,000 steps a day for sustained weight loss. For aerobic fitness, make 3000 of your daily steps with higher intensity.



Abdominal/Hip Flexor ◊ Stand with feet together. ◊ Step forward with one foot and bend knee. ◊ **Keep your weight in both legs,

Do Not Lean into front knee**. ◊ Raise arms up toward ceiling to feel stretch in

abdominals, hold for 2 breaths. ◊ Now, rotate back leg outward to feel stretch in

the top front of your back thigh (hip flexor), hold for 2 breaths.

Adductor (inner thigh) ◊ Stand with feet wide. ◊ Bend one knee into a

side lunge. ◊ You will feel a slight

stretch on the inner thigh of straight leg.

Calf Stretch ◊ Stand with toes on wall - keep leg straight. ◊ Lean into wall bringing your hip forward

until you feel a stretch in your calf. ◊ While holding that stretch, bend your knee

slightly to feel the stretch higher in calf.

Abdominal/QL Stretch ◊ Stand with feet shoulder width apart. ◊ Twist upper body to one side. ◊ Then, lift arms to shoulder level and

continue twisting until you feel a slight stretch.

Hamstring: ◊ Stand with feet together and knees soft. ◊ Slowly bend from the waist and allow

head and hands to fall toward floor. ◊ Slowly curl back up to standing.

IT Band Stretch ◊ Cross right leg over left. ◊ Stick left hip out to side

(not behind you) until you feel a slight stretch in your left outer hip/buttocks area.

Stretching After Exercise

Quad Stretch ◊ Stand (or sit on edge of chair). ◊ Bend right leg and grab ankle with right hand. ◊ Lift heel toward buttocks. ◊ Lower knee so that legs are together and stand

as straight up as possible.



Strength Training Tips

Benefits of strength training Strength training is very beneficial for everyone, but is particularly beneficial for those with or at risk for diabetes. Strength training: Builds strong bones and decreases risk for osteoporosis. Increases muscle mass which improves metabolism. Improves balance. Improves insulin sensitivity. Can help lower blood pressure. Improves glucose control. Helps with weight control and loss of body fat. And much more.

If you have never done any strength training or lifting of weights, it is recommended you get proper instruction from a trainer that is certified or qualified in personal training. Or you could follow a video or good group exercise instructor. Once you know how to perform weight lifting exercises correctly and with proper form, the following guidelines will help you create weekly goals. Strength Training Guidelines Get or create a program that includes 8-10 exercises that work your major muscle groups.

Frequency Plan to do these exercises twice a week or three times for faster results. Take at least 1 day off between working the same muscles, so they can recover. Do the exercises again within at least 4 days, so the muscles will develop faster. You might do all the exercises Monday and Thursday or Tuesday and Friday or Wednesday

and a weekend day. You can also do more exercises and have some days for the upper body and others for the

lower body.

Exercise Sets & Repetitions Each time you lift a weight, it is called a repetition.

The objective is to lift or resist a weight to the point of fatigue (where you can’t do another repetition in good form).

When you lift multiple times in repetition, it is called a set. The recommendation is to do 8-15 repetitions in a set.

If you can easily lift 15 times, then it is time to add additional weight or resistance. If you can only lift 8 times, then each day try to add another repetition until you get to 15.

Start off doing 1 set of each exercise and add more sets when you are ready and can do more. Proper Form Do each exercise in a slow and controlled way. Hold your posture and focus on only using the muscles required to do the exercise.



Summary Exercise is critical to managing and preventing diabetes. Aim for 120-150

minutes on 3-5 days a week at a moderate intensity level of 3-6 on the RPE Scale. Safe progression means starting from where you are and first increasing the

number of days you exercise, then the amount of time each day and then the intensity of your exercise. It’s important just to start moving or move more.

The type of exercise you do depends on what you like and what you have

available. Be creative, make it as fun as you can. Anything that has you moving continuously for at least 10 minutes counts. Try to vary what you do.

Goal setting and logging have been shown to make people more successful at

establishing long-term exercise habits. The Fitness Diary is designed to help you keep track of your goals, progress, achievements, and glucose levels and keep you focused on what you want for yourself.

Stretch after you exercise. Slow down, reduce your stress, hold for 10-30 seconds.

Using a pedometer can be very motivating to move more. It gives you objective

information about your activity level so you know if you are on track.

Strength training is an important component of fitness and of diabetes management. Aim for 2 days a week, 1-3 sets of 8-15 repetitions. Do about 8-10 exercises working your major muscle groups.



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Weekly Observations – also in My Lifestyle Diary

What went well this week with your exercise and activity level? _____________________________________________________________________

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What were your successes – even if it wasn’t a perfect week? What do you learn from that?


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Balanced Eating for Glucose Control



The Story Behind Carbohydrates

Carbohydrates are your primary source of glucose. As carbohydrates are digested, they are broken down into glucose. The faster a carbohydrate breaks down, the faster blood sugar level rises. The slower it digests and breaks down, the slower the levels rise. Carbohydrates are primarily grains, vegetables, fruits, sugar and alcohol. Carbohydrates that have high glycemic indexes are simple carbs. Carbohydrates with lower indexes are called complex carbs.

Simple carbohydrates White or refined breads, cereals, bagels, rolls, crackers,

pasta and white rice. Foods made with sugar, such as baked goods, desserts,

candy, ice cream and sodas. Dairy high in milk sugars, including milk and yogurt. Fruits and fruit juices. Some vegetables, including corn, beets, carrots and tomatoes.

Complex carbohydrates are rich in nutrients and fiber and are slower to impact blood sugar levels than simple carbohydrates. Whole grain breads, crackers, pasta and cereals. Beans, lentils and rice (not enriched rice)

– brown rice, wild rice, basmati rice. Green vegetables, root vegetables (yams, turnips). Most potatoes (but not baked potatoes).

Many starchy vegetables are actually complex carbs. Ways to figure out if a packaged or prepared food is a simple or complex carbohydrate Look on the food label: What is the first ingredient of the bread, pasta, cereal, crackers, bagel, muffin, cookies, etc? If it is: 100% whole grain or whole, rolled, milled grain It is mostly or all complex.

(a grain can be wheat, rye, oats, millet, rice) Enriched grain or refined grain It is mostly or all simple.

Is sugar a high percentage of the total carbohydrates? It is mostly or all simple. Is the amount of fiber above 5 grams a serving? It is mostly or all complex.



Recognizing Carbohydrates, Proteins and Fats

Food is made up of three nutrients – carbohydrates, protein and fat. Your body needs all three of them to survive.

Complex carbohydrates are Breads, rolls, pastas, cereals, crackers – or anything mostly made with whole grains. Rice – all but white rice. Beans – every type of bean – from green beans and soybeans to lentils and chickpeas. Vegetables – all green vegetables and most other vegetables (including squashes).

NOT: corn or tomatoes Root vegetables – nearly all vegetables grown in the ground.

NOT: carrots or beets NOT: baking potatoes – and other potatoes retain their fiber better if boiled not baked Simple carbohydrates are White, refined flour breads, pastries, rolls, pasta, cereal, baked goods. White rice. Desserts, cookies, candy, sugar, syrup, jam, jelly, chocolate. Fruits – even those with lots of fiber. Dairy – milk, yogurt, ice cream, cream.

Complex Carbohydrate Simple Carbohydrate Lean Protein Fatty Protein

Whole grain bread/bagel/roll White bread/bagel/roll/cracker Chicken breast Chicken - darkWhole grain pastas Refined grain pasta Turkey breast Turkey - darkWhole grain cereals Refined grain cereals Beef – lean cuts BeefBrown/wild/basmati Rice White rice Ham Honey baked hamQuinoa (grain) Baked goods/pastry Hamburger – lean HamburgerGreen vegetables Desserts Sausage – lean SausageMost other vegetables Corn, carrots, beets, tomato PorkMost potatoes Baked/instant potatoes FishRoot vegetables Fruits ButterSquashes Fruit juices MargarineBeans/soy beans Jam/jelly CreamLentils Sugar/honey/syrup Peanut butter Cheese

Nuts Whole milkSeedsCottage cheeseLow fat cheese

Milk Low fat milk Canola oilIce cream Soy milk Olive oilYogurt Soybeans Vegetable oils

Tofu Flax oilEgg Fish oilFish Avocados/olives

Saturated Fat

Lean Protein &Mostly Unsaturated Fat

Simple Carbohydrate & Protein (some with Saturated Fat) Unsaturated Fat

Lean protein: Meat that has very little fat. Protein/lean fat: Foods that are a combination of lean protein and unsaturated fat. Saturated fat: Foods that are high in saturated or trans fats. Unsaturated fat: Foods that are high in unsaturated fats and Omega 3s.



Which Carbs Have the Highest Glycemic Index? They glycemic index measures the speed that a specific food breaks down and raises blood sugar.

A high glycemic index is 70 or above. A low glycemic index is 55 or less.

Some high glycemic foods Some lower glycemic foodsCorn muffin 102 100% whole grain bread Baguette, plain 95 - rye, bulgur, wheat 50-60s Scone from mix 92 Basmati rice 57 Gatorade 89 Bran Chex cereal 58 Cornflakes cereal 86 Oatmeal 58 Doughnut, plain 76 Brown rice 50 Cheerios 74 Orange 48

Bran flakes cereal 74 Apple 40 Bagel, plain 72 All-Bran cereal 38 White bread 71 Kidney beans 23 Banana 70 Lentils 22 White rice 69 Peanuts 14

Glycemic Index vs Glycemic Load Glycemic index is the measure for a single food. Glycemic load is a measure of how fast a combination of foods raises blood sugar. How Glycemic Load Works Eating several simple carbohydrates together creates a high glycemic load and high

spike in blood sugar levels. Eating simple carbs with complex carbs reduces the load, but not enough to avoid a

spike in blood sugar levels. A mix of complex carbs further reduces the load, but still elevates blood sugar levels. Eating complex carbs with protein or fat significantly reduces the glycemic load by

slowing down digestion and minimizing a rapid rise in blood sugar levels.

Single food = glycemic index Combined foods = glycemic load Bread on its own has a higher glycemic index. Bread with protein & fat has lower load.



Balancing Foods to Lower the Glycemic Load

Well-balanced means eating a mix of carbohydrates, protein and fat each time you eat, which reduces the glycemic load. The ideal meal or snack is

o 1/2 complex carbohydrates, o 1/4 lean protein, o 1/8 unsaturated fat (about a tablespoon), and o small amount of simple carbs/saturated fat.

Think of meals or snacks you would enjoy that are primarily complex carbohydrates and lean protein and unsaturated fat. Breakfast Ideas Whole wheat toast and peanut butter or slice of low fat cheese. High fiber, whole grain cereal with low fat milk. Vegetable/ham omelet with whole grain toast. Oatmeal with side of turkey sausage. ____________________________________________________________ ____________________________________________________________ Lunch Ideas Lentil or bean soup with whole grain roll. Whole grain pasta with chicken and vegetables in marinara sauce. Grilled chicken breast with salad and whole grain pita. Whole grain pizza with low fat cheese, turkey sausage and vegetables. ___________________________________________________________ ___________________________________________________________ Dinner Ideas Chicken or pork and vegetable stir fry with brown rice. Lean pork chop with red potato and steamed vegetable. Grilled swordfish and roasted vegetables. Broiled salmon with mango chutney and steamed vegetable and brown rice. ___________________________________________________________ ___________________________________________________________ Snack Ideas Nuts and fruit and whole grain crackers. Vegetables or whole grain cracker with cottage cheese or low fat cream cheese.

Whole grain pretzels or crackers with nut butter or laughing cow cheese. Trail mix with fruit. Vegetable soup and whole grain crackers. Grilled whole grain bread, low fat cheese sandwich. ___________________________________________________________ ___________________________________________________________


A Simple, Enjoyable Way to Eat

4 key principles 1) Listen to Hunger Signals

Do you know what it feels like when you are hungry?

Watch to see what indicators you get that tell you that you’re hungry. What are they?

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Do you know when you are getting full? What tells you that you are starting to get full?

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What can you do to stop eating before getting to this point?

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WHY WE EAT BEYOND 6-7…UnconsciousStarted eating at a 0Eating just simple carbohydratesDeprivation backlashEmotions

0 1 2 3 4 5 6 7 8 9 10

0 Ravenous1 Very hungry2 Hungry, ready to eat3 Initial signal of hunger4 Neither hungry nor full5 Neither hungry nor full

6 Satisfied7 Satisfied8 Full9 Uncomfortably full10 Feel sick

If hungry within 1-3 hours – Didn’t eat enough at last meal or ate just carbs

If not hungry for 5-7 hours- Ate too much or not conscious of hunger




2) Balance Carbohydrates with Protein & Fat

Avoid eating just carbohydrates. Instead balance them with lean protein and fat. Carbohydrates are needed to avoid hypoglycemia throughout the day. At each meal or snack, add some protein or healthy fat with your carbohydrates.

List your favorite balanced food combinations for:

Breakfast _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Mid-Morning Snack _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Lunch _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Afternoon Snack _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Dinner _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

If on insulin, pay attention to your carbohydrate intake to match your insulin units. General rule of thumb is:

For every 12 grams of carbohydrates… you will need… 1 unit of insulin. Confirm with your doctor. The ratios vary person to person. For adults: 1 unit of insulin may be needed for every 10 to 20 grams of carbohydrates. For children: 1 unit of insulin may be needed for every 20 to 30 grams.



3) Eliminate Diet-Thinking of Bad Foods

Feeling deprived of what you enjoy leads to obsessions, cravings and bingeing. The goal is choose healthier foods you really enjoy. If you want, make room for a little treat. Have your cake in moderation and eat it

too without driving up your glucose levels and cravings. Focus on the foods and meals you enjoy. Then see if you can find ways to make them healthier by substituting simple carbs

with complex carbs, fatty proteins with leaner ones, and foods with saturated and trans fats with those with unsaturated fats.

The stores now have lots of great options and food companies are making healthier versions of many favorite foods.

What happens when you feel deprived and are told you can’t have what you like? Do you obsess over it? Do you eat it in private? Do you over eat it when you get your hands on it?

Try allowing yourself a bit of it with your meal, so you keep a low glycemic load. Eat it in moderation and in balance with other foods. Once it isn’t forbidden, you will have more control over it, rather than it controlling you. What are some of your forbidden foods that you would like to try eating in moderation with your meals?

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4) Change How You Treat Yourself

It is easy to criticize yourself for eating the wrong things, failing at weight loss and feeling ashamed by how you eat, but this won’t help you succeed. Harsh judgment of what you did or didn’t eat leads to guilt and shame, which in turn leads to emotional eating (overeating) and punishment (under eating). What are you saying to yourself about how or what you are eating? _______________________________________________________________ Is this true? What is a way to say something positive about yourself instead? _______________________________________________________________



Snacking to Maintain Stable Glucose Levels Snacks are important for managing glucose levels during the day and at night. Rules of Thumb Have a small meal or snack when your glucose levels fall below 100 milligrams. Eat when you feel a bit hungry. Hunger signals (even slight ones) indicate a fall in blood sugar levels. It is common to need a small meal or snack mid morning, mid afternoon and at night

– depending on when dinner occurred. Night time eating If you exercise in the evening or eat an early dinner, eat a snack to avoid the risk of

low blood sugars during the night (nighttime hypoglycemia).

Night time Considerations Eat about two hours before going to bed. Eat amount of calories that will burn off before going to bed. The average person

burns 75-100 calories an hour, so eat about 150-200 calories of food 2 hours before bed time or 250-300 if 3 hours ahead.

If taking insulin, eat at least two hours ahead of time to get an accurate reading. Eat protein with carbs to avoid spiking blood sugars with all carbohydrate snacks.

Journaling as a Discovery Tool Food journals are not usually fun. They are if you change how you use them. Discovery Food Journal Use the food journal in this workbook for the purpose of seeing patterns and learning about

yourself and what makes you feel good. The purpose is NOT to see how you are good or bad. This won’t help you feel better. Avoid, as best you can, judgment or guilt, which is what most people associate with food

journals. This is only for your use, so you can make discoveries and understand yourself. Do not judge what you write down. You don’t have to show this to anyone. It is for you. When you overeat or eat unbalanced meals, think, “Isn’t that interesting – I wonder why?” What is important is learning what triggers you to eat when you aren’t hungry and to learn

what makes you feel good and what helps you control your glucose levels. Track your moods, feelings and thoughts and see if you use food to comfort yourself.


How to Use the Discovery Food Journal

Filling in the Journal Put your name, date and day of the week at the top – so you can keep track.

Time Tracking the time helps you see if you are going too long without food or eating frequently.

Food Notice if you are eating a combination of foods that are complex carbs, lean protein and

unsaturated fat – with a bit of the fattier/simple carbohydrates – at each meal or snack. Quantity Learn how much food works to satisfy you without making you feel full.

Hunger Scale Put a mark on the scale when you start to eat AND a second mark when you finish. This will

help you see if you ate when you were hungry or not, and if you got satisfied or full. Mood, Thoughts, Feelings Jot down anything you notice. It will help you learn how food makes you feel and how your

feelings and thoughts affect how you eat. (You can add glucose readings too).

Time Food Quantity 0 1 2 3 4 5 6 7 8 9 10 Mood - Thoughts - Feelings

0 = starving, 10 = overfull (x when start and stop eating on the scale)

Hunger ScaleName _____________________ Date __________ M T W TH F Sa Su




Summary Carbohydrates get broken down into simple sugars and the faster a food gets

broken down, the faster blood sugar levels go up. Glycemic index measures a single food and how fast it drives up blood sugar

levels. Simple carbohydrates drive it up fastest. Complex carbohydrates don’t drive blood sugars up nearly as fast.

Glycemic load measures a combination of foods. When carbohydrates are eaten

with protein and fat, the load is significantly reduced. Balanced eating is a healthy way for diabetics to eat. There are 4 key principles:

1) listen to hunger signals (eat when hungry, stop before full at point satisfied); 2) balance carbs with protein and fat – emphasizing complex carbs, lean protein and unsaturated fat; 3) eat what you enjoy by choosing healthy versions of favorite foods and don’t feel deprived; and 4) avoid judging yourself to limit emotional eating and bingeing.

Snack to maintain normal glucose levels. When eating at night, be aware of

timing, balance and quantities. Get insights about your eating behaviors with a discovery food journal. Learn

about your hunger levels, how specific meals affect you and your glucose readings, and how things trigger you to eat. Simply observe patterns and be curious about what works well for you. Avoid judgment.

References

Intuitive Eating: A Revolutionary Program That Works by Evelyn Tribole, MS, RD and Elyse Resch MS, RD, FADA (1995, 2003) New York: St. Martin’s Griffin Un-Dieting – Un-doing the Diet Mentality and Staying Fit Forever by Jackie Jaye-Brandt, MA, MFT and Diana Lipson-Burge RD (2000) www.1stbooks.com: 1 Books Library st

Life is Hard, Food is Easy by Linda Spangle, RN, MA (2003) Washington, D.C.: Lifeline Press

Photo Sources Page 27: http://health.allrefer.com/pictures-images

Page 29: www.panerabread.com

http://www.1stbooks.com/




What Did I Learn? What Did I Learn?

What did I learn from reading this section or listening to CD3? What did I learn from reading this section or listening to CD3? _____________________________________________________________________ _____________________________________________________________________

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_____________________________________________________________________ _____________________________________________________________________ What are one or two key realizations I am getting from this? What are one or two key realizations I am getting from this? _____________________________________________________________________ _____________________________________________________________________

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_____________________________________________________________________ _____________________________________________________________________ What am I going to do differently now as a result of my realizations? What am I going to do differently now as a result of my realizations?

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What went well this week? _____________________________________________________________________

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What was particularly interesting? What do you learn from that? _____________________________________________________________________

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What are some things you can do this next week that will help you stay in balance? _____________________________________________________________________

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Lifestyle Changes for Prevention & Management of Diabetes


Lifestyle Choices that Improve Glucose Levels

Lifestyle represents what a person does and the choices they make in daily habits. Unhealthy lifestyle choices include: Eating junk food or fast food regularly or as a meal. Supersize portions. Skipping meals and overeating at night. Inactivity. Smoking. Drinking (unless kept to minimum). Not getting enough sleep. Chronic stress.

These choices elevate blood sugar levels and insulin resistance.

Do you find you tend to make unhealthy choices?

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

Which are the hardest to give up, and why?

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

Healthy lifestyle behaviors make a significant difference in blood glucose levels. 7-8 hours of sleep. Daily exercise at moderate levels. Balanced eating, combining complex carbohydrates with lean protein and unsaturated

fat – and eating foods that are simple carbohydrates and saturated fat in moderation. Eating regularly throughout the day. Very minimal drinking. No smoking. Minimized stress. Being supported by loved ones or close friends.

Which of the listed lifestyle behaviors do you think you are ready to adopt?

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________




Lowering Stress Levels Chronic stress is difficult to recognize, because it is familiar. But continual daily stress creates physical and psychological consequences. Affects of chronic stress: Abdominal weight gain. Craving for carbohydrates and simple sugars. Depression and unhappiness. Exhaustion and poor energy. Bingeing and emotional eating. Depletion of vitamins, minerals and brain chemicals. Blocks metabolic hormones, including insulin.

For diabetics, chronic stress makes it harder to get glucose levels under control and to feel up to taking better care of yourself. Stress is a key indicator that you are not taking care of yourself and your needs. Ways to lower stress levels Adopting the healthy lifestyle behaviors on the previous page. Meditation. Yoga. Dancing. Conscious breathing. Guided visualization tapes. Tai Chi. Playing with your pet. Getting out in nature. Listening to music. Other mind-body relaxation techniques.

Do you have any other ideas to lower your stress?

_____________________________________________________________________ _____________________________________________________________________

Has anything worked for you in the past?

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

What would you like to try?

_____________________________________________________________________ _____________________________________________________________________



Addressing the Challenges of Lifestyle Changes It isn’t easy making lifestyle changes. It is easier to follow familiar routines. But being at risk for or being diagnosed with diabetes requires healthier habits. What makes adopting and maintaining lifestyle changes challenging is different for each person. Some common challenges: Ambivalence Feeling depressed. Being discouraged. Denial that the disease will get all that bad. Not having any symptoms.

Not able to take action Feeling angry about a life-threatening diagnosis. Feeling paralyzed. Feeling overwhelmed. Fears that are too difficult to face.

Excuses Not having (making) time. Feeling too tired. Allowing job, family and other obligations to consume the time. Not having enough money. Not able to be perfect in doing everything well enough.

Beliefs Don’t believe lifestyle changes will last. Don’t believe can lose weight. Don’t believe can control glucose levels. Must follow rigid program and rules. Must be good every day or every week.

Do you have some of these challenges? ______________________________________

_____________________________________________________________________ _____________________________________________________________________

What other challenges do you have that make it hard to create new healthier behaviors?

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________



Overcoming the Obstacles We are very often our own biggest obstacle without even knowing it. What we do is shaped by … What we think about. What we believe is right or wrong or what we should or shouldn’t do. What we feel about things.

Our thoughts mostly about the past or future and based on interpretation. validate our beliefs which are often not our own, but from family and society. and impact our feelings which we don’t usually know we are having. which drives our behavior that leads to results we don’t necessarily want or feel good about.

Thoughts Beliefs Feelings Behaviors Results

Example: I don’t have time to exercise. (thought) I must exercise for at least 30 minutes for it to make a difference. (belief) I feel bad and guilty but I just don’t have 30 minutes to exercise now. (feelings) Decision not to exercise. (behavior) Glucose readings remain high. (result) The common reaction to this scenario is judgment (and often harsh self judgment)

such as feeling ashamed or guilty and this validates the belief of being a failure.

This leads to giving up.

The better approach is to turn the judgment into a neutral observation. Be curious about why the decision was to skip exercising. Say, “Isn’t it interesting … I decided not to exercise today. Why is that?”

Maybe 30 minutes is too long a workout for that day. Where does the belief come from that it has to be 30 minutes? Does it really have to be 30 minutes? Who says? Maybe 15-20 minutes works just as well and works better for you.

Judgments stop the inquiry process and keep you feeling badly and down. Observations lead to insights and understanding and, maybe, new choices.

Then you can create new beliefs that help you to be successful. Choose realistic tasks you can accomplish. Recognize your successes, even if you don’t do something 100%.



How to Help Yourself Make Healthy Changes ADDRESS YOUR THOUGHTS Stop saying harsh negative things to yourself – you are what you think. Listen for what you are saying to yourself. Is what you are saying really true? What is really true? How can you be nicer to yourself and be more positive?

ADDRESS YOUR BELIEFS To make lifestyle changes, it helps to believe the following things… The changes are worth doing for your health. You are worth making changes for, even if it impacts other people. The disease is serious enough to warrant healthier behaviors. You are valuable, lovable and deserving.

Do you believe these things? ____________ If not, why not ________________________________________________________

_____________________________________________________________________ ADDRESS YOUR FEELINGS You will better take care of yourself if you feel good about who you are and your life and one way to do this is to focus on appreciation and gratitude. Make a list of 2 things you appreciate about yourself today – appreciate yourself often.

_____________________________________________________________________ _____________________________________________________________________

What do you like most about yourself – or what would others say they like about you?

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

Make a list of 3 things you are grateful for today – and practice daily gratitude.

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________



Getting & Staying Motivated to be Healthy GETTING MOTIVATED What will it take to motivate you to make healthier lifestyle choices? Is it fear of serious complications from diabetes? ___________________ Is it the desire to live an active, healthy life? ___________________ Is it the desire to build a business or a non-profit? ___________________ Is it to be part of your grandchildren’s lives? ___________________ Is it to be energetic enough to make a difference? ___________________ Is it something else? _________________________________________________ What matters to you? What is your vision for your future? This question is easy for some people and very hard for others. Does your vision include great health, doing active things, being around for a long time, or enjoying yourself? Really spend some time thinking and then writing about this. Use more paper if needed.

__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Read what you just wrote daily. This is your inspiration. The more you envision this, the more you aspire to it, and the more it becomes part of your reality. Make a bulletin board or a scrap book with pictures that represent what you want and have it where you can see it and be inspired and excited by it. Setting SMART Goals Don’t try to make lots of changes at once – start off slowly and add changes as you can. Start off with manageable new healthy goals for the day, or for the week.

S pecific Be specific. Choose specific activities to do instead of just saying you’ll exercise. M easurable Use numbers. Indicate the number of days or minutes you will do each time. A ttainable Choose things you can really do or easily get to. Walk instead of aerobics class. R ealistic Know your limitations and constraints. Start off with 20 minutes, instead of 45. T imeframe Create a timeframe within which to reach your goal. This can be for a day, the

week or for 3 months. For example, on Friday I will go for a 20 minute walk. Another example is, by the end of 3 months I will have reached my goal of regularly walking 5 days a walk for at least 30 minutes.



Setting Weekly Goals Recording Goals, Tracking & Observations Regular exercise. Diabetes Fitness Diary. Meal planning for balanced eating. Discovery Food Journal. Stress reduction. Diabetes Fitness Diary – as a comment. Getting enough sleep. Diabetes Fitness Diary – as a comment. Moderation in drinking. Discovery Food Journal – track drinks. Drinking enough water. Discovery Food Journal – track water.

Focus on one or two things and add in additional goals as you incorporate the others into your routine. You don’t want to overwhelm yourself by taking on too much at once. Regular Exercise Start by adding in exercise, because this is going to make you feel better, improve your glucose readings, reduce cholesterol and lower blood pressure. It also helps reduce stress.

First understand what it is you can really do right now, and listen to your body.

What are your physical limitations? Can you walk or be active for 10, 20 or 30 minutes without getting winded?

I can: ________________________________________________________ What can you fit into your schedule? Where can you find a time to get exercise or an aerobic activity in during the week?

I can: ________________________________________________________ What would you enjoy doing – that is accessible – that will get your heart rate up?

I would like to: _________________________________________________

How many times during the week can you make time for this?

I can do this: ______ times Balanced Eating The second best thing to focus on is meal planning and paying attention to your hunger levels.

When can you set aside time to plan what you need for groceries and meals?

I can: ________________________________________________________ When can you get to the store to get foods that are balanced and healthy?

I can: ________________________________________________________



STAYING MOTIVATED It isn’t easy staying motivated once you’ve gotten started on new lifestyle habits. It is too easy to go back to your old ways after a couple of months doing a new habit. This is what you want to avoid.

You want to make these new changes a way of life that are easy to maintain. That is why you start off doing things you enjoy and that are realistic for you. Then add more changes and progress as you feel you are ready to make more improvements. To stay on track, You need support from someone you respect that is not judgmental. You need a way to be accountable for what you said you would do. You need to be recognized for your successes. You need help to address the obstacles and challenges that come up. You need flexibility, because life does and will get in the way.

Who can support you that won’t push you too hard or sabotage your efforts?

For exercise: __________________________________________________ For eating: __________________________________________________ For de-stressing: ______________________________________________ For _________________________________________________________

Who can you buddy up with?

_____________________________________________________________ _____________________________________________________________

Who can help you stay on track?

_____________________________________________________________ _____________________________________________________________

Remember to focus on treating yourself well.

Treat and take care of yourself like you would a 4 year old child. • How would you talk to him? • How would you plan her food for the day? • What would you teach and model for him to believe about himself? • How would you handle her feelings?



Summary A healthy lifestyle for diabetics is not very different than for other people.

What is different is the impact of not making healthier lifestyle changes on diabetics. It makes the disease worse and accelerates complications.

Stress may not seem like a big deal, but it actually affects the body in many

ways that impact those who are at risk for or who have diabetes. Stress blocks insulin, increases weight around the waist, depletes nutrients and brain chemicals, and leads to carbohydrate cravings. There are lots of ways to reduce stress that are easy and enjoyable to do.

Lifestyle changes are difficult to make for diabetics for a couple of reasons.

There are few symptoms early on, and medications appear to keep blood sugar levels under control. As a result, there isn’t enough incentive to make or maintain changes in activity levels, eating choices, sleep habits, or alcohol quantities.

It is important to understand what your obstacles are to healthier choices. The

most common challenges are ambivalence, inability to take action, excuses and beliefs.

What we think and believe impacts what we feel and do. Thoughts (most of

which aren’t based on fact) validate beliefs (most of which aren’t our own) and create feelings (that we don’t realize we have), which leads to behaviors (that we harshly judge). With non-judgmental observation it is possible to replace negative thoughts and unwanted beliefs with new ones that lead to positive behaviors.

Having a vision of what really matters in life and what is worth living for

provides the motivation to make long term lifestyle changes. Envisioning positive outcomes is more motivating than avoiding a negative outcome, such as an early death or complication from diabetes. Instead envision what is inspiring.

Creating realistic goals and having a support system for accountability makes

all the difference in staying motivated and on track. Start off with goals that are feasible, enjoyable and not too overwhelming. This makes it easier to succeed, stick with them and make progress. To stay on track, accountability is important and makes it easier to follow through on the goals.


What Did I Learn? What Did I Learn?

What did I learn from reading this section or listening to CD4? What did I learn from reading this section or listening to CD4? _____________________________________________________________________ _____________________________________________________________________

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_____________________________________________________________________ _____________________________________________________________________ What am I going to do differently now as a result of my realizations? What am I going to do differently now as a result of my realizations?

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What went well this week? _____________________________________________________________________

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What was particularly interesting? What do you learn from that? _____________________________________________________________________

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_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

What are some things you can do this next week that will help you stay motivated? _____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________



My Lifestyle Diary

for the Week of ____________



Using Your Diary

THE BENEFITS OF A DIARY A place for you to learn more about yourself. A tool to create and support new lifestyle habits. A way to be accountable to yourself.

For those participating in a coaching program, it is also a way to capture things that you want to share and talk about in the coaching sessions. STARTING WITH A VISION Making changes in your life isn’t easy without feeling motivated enough to make them, and that is what a vision of what you want for yourself will help you do. When you envision the benefits of staying healthy to live the life you want for yourself, you know why it is worth making lifestyle changes to achieve that for yourself. WEEKLY SELF PROGRESS TRACKING

Diabetes Fitness Diary Decide how many days and which days of the coming week you are planning

exercise. Record the type of exercise and duration of that exercise session on the days you are planning to exercise.

Before you begin exercising, check your glucose levels and record in the pre-exercise glucose box. Make sure your levels are between 90 and 270 mg/dl.

Perform your exercise session and record the data from that session on the diary. Type of exercise, duration, RPE, and post-exercise glucose levels. (see the section on Exercise Guidelines for more info)

If you are keeping track of your steps, record them for both exercise steps and daily steps.

Discovery Food Journal Time: Tracking the time helps you see if you are going too long without food or

eating frequently. Food: Notice if you are eating a combination of foods that are complex

carbohydrates, lean protein and unsaturated fat – allowing for a bit of simple carbohydrates or saturated fat if needed for satisfaction – at your meal or snack.

Quantity: Learn how much works to satisfy you without making you feel full. Hunger Scale: Put a mark on the scale when you start to eat AND a second mark

when you finish. This will help you see if you ate when you were hungry or not, and if you got satisfied or full.

Mood, Thoughts, Feelings: Jot down anything you notice. It will help you learn how food makes you feel and how your feelings and thoughts affect how you eat. (You can add glucose readings too).



Creating a Vision of Being at Your Best

VISION OF ME LIVING AT MY BEST What do I want to do with my life? (e.g., make a difference, follow a passion, be there for others, fulfill a mission or promise, to fully enjoy what life has to offer, …)

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

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VISION A YEAR FROM NOW What is my vision 1 year from now for my health? (e.g., have A1c below 6%, be diabetes free, 40 pounds lighter, lots of energy, able to complete 26 mile walk, …)

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

3 MONTH GOALS FOR MYSELF What are my 3 month goals? (e.g., participate in 3k walk, able to exercise 4x week for 30 minutes, not winded when going up a flight of stairs, wearing size smaller clothes, …)

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

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Planning For the Week

SETTING YOUR GOALS Exercise Goals # of Days # of _______* # of ________* Aerobic activity: ________ ___________ ___________

Strengthening: ________ ___________ ___________

Stretching: ________ ___________ ___________

Other: ________ ___________ ___________

* (you decide what goals you are tracking)

Eating Goals – consider some of these goals for the week Awareness of hunger levels: ______________________________

Tracking glucose levels: ______________________________

Balancing carbs, protein & fat: ______________________________

Finding balanced snacks or meal ideas: ______________________________

Better planning and preparation ideas: ______________________________

Other: ______________________________________________________

Other: ______________________________________________________

NEW STRATEGIES Have you identified new ways of handling situations, dealing with challenges, getting the support you need, or any other ideas or solutions that will help you to reach your goals and stay on track that you want to try this week?

New way of dealing with: ___________________

I want to try: ____________________________________________________


I want to try: ____________________________________________________


I want to try: ____________________________________________________

Other things I want to do:

_______________________________________________________

Other things I want to do:

_______________________________________________________



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This Week’s Accomplishments

FITNESS Total number of exercise sessions and amount of time: Number of sessions: Goal _________ Actual _________

Amount of time: Goal _________ Actual _________

What went well? ________________________________________________

Average glucose drop during exercise: __________

Any unusual highs or lows in glucose levels? __________________________

Was your RPE between 3 and 6? ___________

What RPE did you feel most comfortable exercising in? __________________

How many average steps did you take during exercise? ___________

How many average steps did you take daily? (total/7days) ___________

FOOD

What went well this week? _______________________________________________

Are you eating every 3-4 hours on average? _____________________

How often are you eating when you get hungry at a 2? _____________________

How often are you stopping when you are satisfied (6-7)? _____________________

Which meals are you more often eating foods in balance? _____________________

Are you enjoying your foods and feeling satisfied? _____________________

When you over eat or skip meals, what do you observe? _____________________

_____________________________________________________________________

What can you learn from this for the next time you are in a similar situation?

_____________________________________________________________________

Is there anything you notice that is unusual or better about your blood sugar levels in

relation to what and when you are eating?

_____________________________________________________________________



This Week’s Observations

LIFESTYLE Other Goals: Planned Actual

________________________ _______ ______

________________________ _______ ______

What went particularly well? _____________________________________________________________

How many hours of sleep are best for you?_________

How many hours did you get on average?_________

How often did you take care of your need for some relaxation, enjoyment and quality time for your self ? ______________

What do you find helped the most to put yourself first?

______________________________________________________________

Rate your stress level this week on a scale of 1-10 (1 being no stress, felt calm and in

control) to 10 (total overwhelm and out of control).

Stress level this week averaged a # ________

How many days of calm did you have?__________

How many days of overwhelm? _______________

Did your stress level lead to overeating and/or not exercising?____________

Did you notice some thinking that is interfering with making healthy changes?

____________________________________________________________________

____________________________________________________________________

What beliefs did you become aware of that are not supporting you?

____________________________________________________________________

____________________________________________________________________



Assessment for the week

FITNESS, FOOD & SELF-CARE What went well this week in relation to lifestyle issues?

What obstacles or challenges did you notice this week? What did you learn from that?

Did you notice any judgments of yourself that you could turn into an observation? Practice writing it out here.

What one action could you take this week to take better care of yourself?



Journaling Time

How would my life be different if I didn’t have or wasn’t at risk for diabetes?

Are there things I can’t physically do that are holding me back from the life I want?

Am I compromising my life choices because of my health and fitness level?

If I had my blood sugar levels always under control by living a healthy lifestyle, what would that give me? What would I be able to do that I want to do? How would I feel?



Journaling Time

What is more important each day than taking care of my health? What is it costing me if I don’t? How can I change this?

What will it take to put myself first, so I can be strong and well enough to be there for others and for what means so much to me?

Have I dealt with the feelings I have about this disease and its impact on my life?

What else do I need to support me?





Additional Resources

Weekly Diary & Journal Pages

You may freely download additional pages from the Living Free with Diabetes website by registering as an owner of this lifestyle guide.

Go to www.livingfreediabetes.com for:

Fitness Diary Pages Discovery Food Journal Pages

Recommended Reading

The First Year – Type 2 Diabetes: An Essential Guide for the Newly Diagnosed by Gretchen Becker (2001) New York: Marlowe & Company

Conquering Diabetes: A Complete Program for Prevention and Treatment by Anne L Peters, MD (2006) New York: Plume, a member of Penguin Group

Blood Sugar Blues: Overcoming the Hidden Dangers of Insulin Resistance by Miryam Ehrlich Williamson and R Raul St. Amand, MD (2001) New York: Walker & Company

Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars by Richard K. Bernstein, MD (1997, 2003, 2007) New York: Little, Brown and Company

Diabetes Self Management magazine www.diabetesselfmanagement.com

DLife online www.dlife.com

Recommended Resource

New-Lifestyles for pedometers (NL-2000) www.new-lifestyles.com


About the Authors Alice Greene

Healthy Lifestyle Coach

Intuitive Eating Coach

Feel Your Personal Best

Newburyport, MA

www.feelyourpersonalbest.com

Ann Seelye

Lifestyle Fitness Coach


Radiant Wellness Designs

Brookline, MA

www.wiseandwellwomen.com

Lisa Atkinson

Master Fitness by Phone® Coach

Health Coach


A Better Way to Fitness

Leesburg, VA

www.abetterway2fitness.com




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